Basic Information
| Provider Information | |||||||||
| NPI: | 1174567895 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ANDREW | ||||||||
| FirstName: | MARK | ||||||||
| MiddleName: | HENRY | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1316 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | CLARION | ||||||||
| State: | IA | ||||||||
| PostalCode: | 505252019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5155322811 | ||||||||
| FaxNumber: | 5155329336 | ||||||||
| Practice Location | |||||||||
| Address1: | 1316 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | CLARION | ||||||||
| State: | IA | ||||||||
| PostalCode: | 505252019 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5155322811 | ||||||||
| FaxNumber: | 5155329336 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2006 | ||||||||
| LastUpdateDate: | 02/21/2017 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 26628 | WI | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | 38005 | IA | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.